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<form action="${domain}/admin/second/e" method="post" name="message" onsubmit="return checkForm(this)">
    <input name="oName" type="hidden" value="${oName}">
    <div width="1000" align="center">
        <h3>表6  2016年社区卫生服务中心/卫生院公共卫生服务收支情况</h3>
        <table border="1" cellspacing="0" cellpadding="0">
            <tr>
                <th rowspan="2">服务项目</th>
                <th colspan="3">服务收费情况</th>
                <th colspan="3">服务支出情况</th>
            </tr>

            <tr>

                <td>年度收费总额（元）</td>
                <td>服务量（人次）</td>
                <td>次均收费水平（元/人次）</td>
                <td>卫生材料支出（元）</td>
                <td>药品支出（元）</td>
                <td>其他支出（元）</td>
            </tr>

            <tr>
                <td><input readonly unselectable="on" name="secondE[0]" value="建立居民健康档案" type="hidden">建立居民健康档案</td>
                <td><input name="secondE[1]" type="number" step="0.01"  ></input></td>
                <td><input name="secondE[2]" type="number" step="0.01"  ></input></td>
                <td><input name="secondE[3]" type="number" step="0.01"  ></input></td>
                <td><input name="secondE[4]" type="number" step="0.01"  ></input></td>
                <td><input name="secondE[5]" type="number" step="0.01"  ></input></td>
                <td><input name="secondEl[0]" type="number" step="0.01"  ></input></td>
            </tr>

            <tr>

                <td><input readonly unselectable="on" name="secondE[6]" value="健康教育" type="hidden">健康教育</td>
                <td><input name="secondE[7]" type="number" step="0.01"  ></input></td>
                <td><input name="secondE[8]" type="number" step="0.01"></td>
                <td><input name="secondE[9]" type="number" step="0.01"></td>
                <td><input name="secondE[10]" type="number" step="0.01"></td>
                <td><input name="secondE[11]" type="number" step="0.01"></td>
                <td><input name="secondEl[1]" type="number" step="0.01"  ></input></td>
            </tr>

            <tr>
                <td><input readonly unselectable="on" name="secondE[12]" value="预防接种" type="hidden">预防接种</td>
                <td><input name="secondE[13]" type="number" step="0.01" ></input></td>
                <td><input name="secondE[14]" type="number" step="0.01"></input></td>
                <td><input name="secondE[15]" type="number" step="0.01"></input></td>
                <td><input name="secondE[16]" type="number" step="0.01"></input></td>
                <td><input name="secondE[17]" type="number" step="0.01"></input></td>
                <td><input name="secondEl[2]" type="number" step="0.01"  ></input></td>
            </tr>


            <tr>
                <td><input readonly unselectable="on" name="secondE[18]" value="   其中：免疫规苗" type="hidden">&nbsp&nbsp&nbsp&nbsp其中：免疫规划</td>
                <td><input name="secondE[19]" type="number" step="0.01" ></input></td>
                <td><input name="secondE[20]" type="number" step="0.01"></input></td>
                <td><input name="secondE[21]" type="number" step="0.01"></input></td>
                <td><input name="secondE[22]" type="number" step="0.01"></input></td>
                <td><input name="secondE[23]" type="number" step="0.01"></input></td>
                <td><input name="secondEl[3]" type="number" step="0.01"  ></input></td>
            </tr>

            <tr>
                <td><input readonly unselectable="on" name="secondE[24]" value="    自费疫苗" type="hidden"> &nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp       自费疫苗</td>
                <td><input name="secondE[25]" type="number" step="0.01" ></input></td>
                <td><input name="secondE[26]" type="number" step="0.01" ></input></td>
                <td><input name="secondE[27]" type="number" step="0.01" ></input></td>
                <td><input name="secondE[28]"  type="number" step="0.01"></input></td>
                <td><input name="secondE[29]"  type="number" step="0.01"></input></td>
                <td><input name="secondEl[4]" type="number" step="0.01"  ></input></td>
            </tr>

            <tr>
                <td><input readonly unselectable="on" name="secondE[30]" value="儿童健康管理" type="hidden">儿童健康管理</td>
                <td><input name="secondE[31]" type="number" step="0.01" ></input></td>
                <td><input name="secondE[32]" type="number" step="0.01"></input></td>
                <td><input name="secondE[33]" type="number" step="0.01"></input></td>
                <td><input name="secondE[34]" type="number" step="0.01"></input></td>
                <td><input name="secondE[35]" type="number" step="0.01"></input></td>
                <td><input name="secondEl[5]" type="number" step="0.01"  ></input></td>
            </tr>
            <tr>
                <td><input readonly unselectable="on" name="secondE[36]" value="孕产妇健康管理" type="hidden">孕产妇健康管理</td>
                <td><input name="secondE[37]" type="number" step="0.01" ></input></td>
                <td><input name="secondE[38]" type="number" step="0.01"></input></td>
                <td><input name="secondE[39]" type="number" step="0.01"></input></td>
                <td><input name="secondE[40]" type="number" step="0.01"></input></td>
                <td><input name="secondE[41]" type="number" step="0.01"></input></td>
                <td><input name="secondEl[6]" type="number" step="0.01"  ></input></td>
            </tr>
            <tr>
                <td><input readonly unselectable="on" name="secondE[42]" value="老年人健康管理" type="hidden" >老年人健康管理</td>
                <td><input name="secondE[43]" type="number" step="0.01" ></input></td>
                <td><input name="secondE[44]" type="number" step="0.01"></input></td>
                <td><input name="secondE[45]" type="number" step="0.01"></input></td>
                <td><input name="secondE[46]" type="number" step="0.01"></input></td>
                <td><input name="secondE[47]" type="number" step="0.01"></input></td>
                <td><input name="secondEl[7]" type="number" step="0.01"  ></input></td>
            </tr>
            <tr>
                <td><input readonly unselectable="on" name="secondE[48]" value="慢性病管理" type="hidden">慢性病管理</td>
                <td><input name="secondE[49]" type="number" step="0.01" ></input></td>
                <td><input name="secondE[50]" type="number" step="0.01"></input></td>
                <td><input name="secondE[51]" type="number" step="0.01"></input></td>
                <td><input name="secondE[52]" type="number" step="0.01"></input></td>
                <td><input name="secondE[53]" type="number" step="0.01"></input></td>
                <td><input name="secondEl[8]" type="number" step="0.01"  ></input></td>
            </tr>
            <tr>
                <td><input readonly unselectable="on" name="secondE[54]" value="  其中：高血压" type="hidden">&nbsp&nbsp&nbsp&nbsp其中：高血压</td>
                <td><input name="secondE[55]" type="number" step="0.01" ></input></td>
                <td><input name="secondE[56]" type="number" step="0.01"></input></td>
                <td><input name="secondE[57]" type="number" step="0.01"></input></td>
                <td><input name="secondE[58]" type="number" step="0.01"></input></td>
                <td><input name="secondE[59]" type="number" step="0.01"></input></td>
                <td><input name="secondEl[9]" type="number" step="0.01"  ></input></td>
            </tr>
            <tr>
                <td><input readonly unselectable="on" name="secondE[60]" value="    糖尿病" type="hidden">&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp糖尿病</td>
                <td><input name="secondE[61]"  type="number" step="0.01"></input></td>
                <td><input name="secondE[62]" type="number" step="0.01"></input></td>
                <td><input name="secondE[63]" type="number" step="0.01"></input></td>
                <td><input name="secondE[64]" type="number" step="0.01"></input></td>
                <td><input name="secondE[65]" type="number" step="0.01"></input></td>
                <td><input name="secondEl[10]" type="number" step="0.01"  ></input></td>
            </tr>
            <tr>
                <td><input readonly unselectable="on" name="secondE[66]" value="严重精神障碍患者管理" type="hidden">严重精神障碍患者管理</td>
                <td><input name="secondE[67]" type="number" step="0.01" ></input></td>
                <td><input name="secondE[68]" type="number" step="0.01"></input></td>
                <td><input name="secondE[69]" type="number" step="0.01"></input></td>
                <td><input name="secondE[70]" type="number" step="0.01"></input></td>
                <td><input name="secondE[71]" type="number" step="0.01"></input></td>
                <td><input name="secondEl[11]" type="number" step="0.01"  ></input></td>
            </tr>
            <tr>
                <td><input readonly unselectable="on" name="secondE[72]" value="结核病患者健康管理" type="hidden">结核病患者健康管理</td>
                <td><input name="secondE[73]" type="number" step="0.01" ></input></td>
                <td><input name="secondE[74]" type="number" step="0.01"></input></td>
                <td><input name="secondE[75]" type="number" step="0.01"></input></td>
                <td><input name="secondE[76]" type="number" step="0.01"></input></td>
                <td><input name="secondE[77]" type="number" step="0.01"></input></td>
                <td><input name="secondEl[12]" type="number" step="0.01"  ></input></td>
            </tr>
            <tr>
                <td><input readonly unselectable="on" name="secondE[78]" value="中医药健康管理" type="hidden">中医药健康管理</td>
                <td><input name="secondE[79]" type="number" step="0.01" ></input></td>
                <td><input name="secondE[80]" type="number" step="0.01" ></input></td>
                <td><input name="secondE[81]" type="number" step="0.01" ></input></td>
                <td><input name="secondE[82]" type="number" step="0.01" ></input></td>
                <td><input name="secondE[83]"  type="number" step="0.01"></input></td>
                <td><input name="secondEl[13]" type="number" step="0.01"  ></input></td>
            </tr>
            <tr>
                <td><input readonly unselectable="on" name="secondE[84]" value="传染病和突发公共卫生事件报告和处理" type="hidden">传染病和突发公共卫生事件报告和处理</td>
                <td><input name="secondE[85]" type="number" step="0.01" ></input></td>
                <td><input name="secondE[86]" type="number" step="0.01"></input></td>
                <td><input name="secondE[87]" type="number" step="0.01"></input></td>
                <td><input name="secondE[88]" type="number" step="0.01"></input></td>
                <td><input name="secondE[89]" type="number" step="0.01"></input></td>
                <td><input name="secondEl[14]" type="number" step="0.01"  ></input></td>
            </tr>
            <tr>
                <td><input  name="secondE[90]" value="卫生计生监督协管" type="hidden"  readonly unselectable="on">卫生计生监督协管</td>
                <td><input name="secondE[91]"  type="number" step="0.01"></input></td>
                <td><input name="secondE[92]" type="number" step="0.01"></input></td>
                <td><input name="secondE[93]" type="number" step="0.01"></input></td>
                <td><input name="secondE[94]" type="number" step="0.01"></input></td>
                <td><input name="secondE[95]" type="number" step="0.01"></input></td>
                <td><input name="secondEl[15]" type="number" step="0.01"  ></input></td>
            </tr>
            <tr>
                <td><input  name="secondE[96]"></td>
                <td><input name="secondE[97]"  type="number" step="0.01"></input></td>
                <td><input name="secondE[98]" type="number" step="0.01"></input></td>
                <td><input name="secondE[99]" type="number" step="0.01"></input></td>
                <td><input name="secondE[100]" type="number" step="0.01"></input></td>
                <td><input name="secondE[101]" type="number" step="0.01"></input></td>
                <td><input name="secondEl[16]" type="number" step="0.01"  ></input></td>
            </tr>
            <tr>
                <td><input  name="secondE[102]" ></td>
                <td><input name="secondE[103]"  type="number" step="0.01"></input></td>
                <td><input name="secondE[104]" type="number" step="0.01"></input></td>
                <td><input name="secondE[105]" type="number" step="0.01"></input></td>
                <td><input name="secondE[106]" type="number" step="0.01"></input></td>
                <td><input name="secondE[107]" type="number" step="0.01"></input></td>
                <td><input name="secondEl[17]" type="number" step="0.01"  ></input></td>
            </tr>
            <tr>
                <td><input  name="secondE[108]" ></td>
                <td><input name="secondE[109]"  type="number" step="0.01"></input></td>
                <td><input name="secondE[110]" type="number" step="0.01"></input></td>
                <td><input name="secondE[111]" type="number" step="0.01"></input></td>
                <td><input name="secondE[112]" type="number" step="0.01"></input></td>
                <td><input name="secondE[113]" type="number" step="0.01"></input></td>
                <td><input name="secondEl[18]" type="number" step="0.01"  ></input></td>
            </tr>
            <tr>
                <td><input  name="secondE[114]" ></td>
                <td><input name="secondE[115]"  type="number" step="0.01"></input></td>
                <td><input name="secondE[116]" type="number" step="0.01"></input></td>
                <td><input name="secondE[117]" type="number" step="0.01"></input></td>
                <td><input name="secondE[118]" type="number" step="0.01"></input></td>
                <td><input name="secondE[119]" type="number" step="0.01"></input></td>
                <td><input name="secondEl[19]" type="number" step="0.01"  ></input></td>
            </tr>

        </table>
        <p align=left>
            注：</br>
            1、如本机构无某一服务项目，请在对应的单元格中填横线。</br>
            2、如提供的是免费服务，则收费总额和收费水平栏填写“0”。</br>
            3、表中没有列出的公共卫生服务项目，需在最后的空行中补充填写。</br>
            4、其他支出主要指开展该项服务时直接发生的印刷费、宣传费、邮寄费、公务用车运行维护费和其他交通费用等支出。</br>
        </p>
        <button type="submit"><b>提交并进入下一表格</b></button>

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